Indigenous medical workers say Joyce Echaquan’s death is the latest tragic symptom of a longstanding health care crisis

Indigenous medical workers say Joyce Echaquan’s death is the latest tragic symptom of a longstanding health care crisis

By Angelyn Francis

Local Journalism Initiative Reporter

Joyce Echaquan

Joyce Echaquan, a 37-year-old Atikamekw mother of seven, tragically died in  hospital while nurses attending to her uttered racist remarks and Echaquan  shared a live video on Facebook. Her death has called attention to a health-care  system that Indigenous medical workers say has been failing to serve Indigenous  people for years.

Cheryllee Bourgeois is a Metis “exemption midwife” with Seventh Generation  Midwives Toronto. She said that when speaking with friends and colleagues about  Echaquan’s death, people would share that they had similar experiences.

“I can’t tell you since I first heard about it on Tuesday, how many people  have said, `Yeah, my family actually had an incident like that X number of years  ago,’ or, you know, `last year when my dad died.’ ”

Exemption midwives are regulated through a community process instead of  through the College of Midwives of Ontario, which allows them to broaden their  scope of care for Indigenous women. For example, they are able to perform STI  tests and Pap tests on women who are not pregnant, while midwives can usually  only perform on women who are pregnant.

“It provides a different way than in the usual health-care system,” Bourgeois  said. It makes a difference for women knowing that their practitioner is “also  Indigenous, and also (has) understandings and teachings that go along with how  you care for yourself.”

At the same time, Bourgeois recognizes the privilege to be able to provide or  have access to someone like an exemption midwife, which only exists in Ontario  and Quebec, and says change is needed beyond that.

“A transformative health-care system really has to be the full system,”  Bourgeois said. “So often, when you go into these spaces, you’re treated as not  human enough. And then what ends up happening is you see the outcomes of that  dehumanization, in situations like the one that happened with Joyce. But Joyce’s  situation is not uncommon.”

Another recent example is Brian Sinclair, an Ojibwa man, who in 2008 died  in a Winnipeg emergency room, where he waited for 34 hours and was not seen by  hospital staff who assumed he was intoxicated, or homeless, or had been  previously discharged.

The inquest found that he died  of a treatable bladder infection and had a referral letter from a physician  in his pocket. Some academics and physicians say his cause of death was  racism.

The history of colonization in this country is fraught with appalling health  experiences for Indigenous people, from smallpox brought early on by settlers,  to the spread of tuberculosis and other illnesses in residential schools.

In a press conference, Quebec Premier Francois Legault said he was shocked at  the racism Echaquan endured, but he refused to acknowledge that Indigenous  people experience systemic racism in Quebec institutions.

For Dr. Lisa Richardson, a mixed Anishinaabe physician who is the strategic  lead in Indigenous health for Women’s College Hospital and U of T, the existence  of systemic racism in health care is a truth with several reports to back it up,  but a truth that people seem afraid to acknowledge. “We will not have  reconciliation, until we have truth,” she says.

Dr. Suzanne Shoush, a Black and Indigenous physician and Indigenous health  lead at U of T’s department of family and community medicine, agrees that  Echaquan’s death should not be seen as a “two rotten eggs” situation. “All of  this treatment is not unique to Joyce,” she said. “I want it to be seen as  systemic and structural.”

Medicine runs on algorithms and stereotypes, Dr. Shoush said.

Doctors look  for patterns and symptoms to determine what looks like appendicitis or what  looks like a stomachache. But when racist stereotypes are in the mix, the result  can be deadly in the form of misdiagnosis, overlooked symptoms or failure to  treat.

“If you’re not culturally competent you, you can kill people,” she said.

If care and history are taken into account, the experience for Indigenous  people can be different. Dr. Shoush remembers a patient of hers who was a  residential school survivor and asked to be taken to the hospital to get help  for substance abuse. During the patient’s intake, it was discovered that she had  scabies, and she was isolated in a room.

“To walk into an institution that is not Indigenous, not seeing any  Indigenous faces, immediately be told, oh, you’re dirty, get into this room,  stripped (of) your clothes” and belongings, Dr. Shoush said. “It was such a  triggering reminder of residential school that she fled.”

A small but powerful detail could come about in what is hanging on the walls.  For example, Dr. Shoush said that over the years, as LGBTQI people’s difficulty  accessing fair health care was recognized, clinics have begun posting positive  signage.

“We are telling people from the LGBTQ community, we see you, we care about  you, you are important, we will not discriminate, we will make an active effort  to not discriminate,” she said.

“If an Indigenous person walks into a room, what do they have in the physical  environment to show that they’re that this is a place for Indigenous people  where they are welcomed and will be treated with dignity?”

Bourgeois said that all health-care providers need to understand that they  have to be mindful of their approach when caring for a patient who has a  mistrust of the system, even for herself as a Metis midwife. “I still am a  health-care provider, that could be a potential harm to somebody. So, it’s  important to remember that, for all health-care providers, that you need to keep  that humility in terms of the care you’re providing.”

She also said similar challenges exist for Black communities, other  racialized people and people who are vulnerable to being targeted by  systems.

“We can hold individuals responsible for their individual behaviour, and we  should,” Bourgeois said. “But unless you look at the systems that are holding  them up and change those, it’s going to continue.”

Angelyn Francis is a Local Journalism Initiative reporter who works out of the Toronto Star. The Local Journalism Initiative is funded by the Government of Canada.

Add Your Voice

Is there more to this story? We’d like to hear from you about this or any other stories you think we should know about. Contribute your voice on our contribute page.